MCQs In Pharmacy Practice
MCQs in Pharmacy Practice
MCQs in Pharmacy PracticeSecond editionEdited byLilian M AzzopardiBPharm (Hons), MPhil, PhD, MRPharmSAssociate Professor and Head of DepartmentDepartment of PharmacyUniversity of MaltaMsida, MaltaLondon Chicago
Published by the Pharmaceutical PressAn imprint of RPS Publishing1 Lambeth High Street, London SE1 7JN, UK100 South Atkinson Road, Suite 200, Grayslake, IL 60030–7820, USA Pharmaceutical Press 2004, 2009is a trade mark of RPS PublishingRPS Publications is the publishing organisation of the RoyalPharmaceutical Society of Great BritainFirst published 2004Second edition 2009Typeset by J&L Composition, Scarborough, North YorkshirePrinted in Great Britain by TJ International, Padstow, CornwallISBN 978 0 85369 839 5All rights reserved. No part of this publication may be reproduced,stored in a retrieval system, or transmitted in any form or by any means,without the prior written permission of the copyright holder.The publisher makes no representation, express or implied, withregard to the accuracy of the information contained in this book andcannot accept any legal responsibility or liability for any errors or omissions that may be made.The right of Lilian M Azzopardi to be identified as the author of thiswork has been asserted by her in accordance with the Copyright, Designsand Patents Act, 1988.A catalogue record for this book is available from the British Library.
ContentsForeword to the second edition by C Anderson viiForeword to the first edition by HR Manasse Jr ixPreface to the second edition xiiiPreface to the first edition xvIntroduction xviiAcknowledgements xxiAbout the editor xxiiiContributors xxvHow to use this book xxviiSection 1 Open-book QuestionsTest QuestionsAnswers327456789111133151Section 2 Closed-book Questions173Test 5175201219243Test 2Test 3Test 4Test 6QuestionsAnswersQuestionsAnswers
viContentsTest 7Test dix AAppendix BAppendix CAppendix D343Proprietary (trade) names andequivalent generic names 345Definitions of conditions 353Abbreviations and acronyms 359Performance statistics 361Proprietary names index 385Generic names index 389Conditions index 397Subject index 407261287305325
Foreword to the second editionThe International Pharmaceutical Federation (FIP) has stated:‘Maintaining competence throughout a career during whichnew and challenging professional responsibilities will beencountered is a fundamental ethical requirement for allhealth professionals. Patients have a right to be confident thatprofessionals providing health care remain competent throughout their working lives.’ (Statement of Professional Standardson Continuing Professional Development. The Hague: FIP,2002.)To become competent and effective pharmacists, there is aneed for preregistration trainees and practising pharmacists tohave a strong background knowledge as well as the ability toretrieve, to evaluate critically and to apply that knowledge indecision making. It is also important that, as part of the continuing professional development (CPD) process, pharmacistskeep informed and continuously revise and assess their knowledge. Furthermore, during their career many pharmacists movefrom one sector of the profession to another or change theirrole within a particular sector. Pharmacists will need to updatetheir knowledge in order to become competent and skilledpractitioners in new areas.Multiple choice questions are increasingly used to testknowledge and understanding objectively at an undergraduatelevel and in licensing exams. They can be formative as selfassessment exercises with feedback and are particularly usefulfor revision purposes and as a means of identifying an area forfurther study.
viiiForeword to the second editionThis book provides the reader with a variety of practiceMCQs, which can be used to assess essential pharmacy practiceknowledge in a number of areas, including drug action, uses,clinical pharmacology, adverse effects, pharmaceutical care,counselling points, product selection and pharmaceuticalcalculations. It will be a very useful text both for pharmacypreregistration examination candidates and for practisingpharmacists.Professor Claire AndersonSchool of Pharmacy, Faculty of Science, University ofNottingham, United KingdomApril 2009
Foreword to the first editionTo practise pharmacy effectively and accountably, it is criticalfor practitioners to have a sound, contemporary and comprehensive database. In addition to the many good references intextbooks and the periodical literature, there is a certainamount of knowledge that we have to keep current in our memory and daily dialogue. An appropriate balance must be struckby our reliance on memory and our capacity to find, analyseand apply useful knowledge to effective clinical decision making. Much discussion is currently ongoing around the world ofthe ideas captured in the phrase ‘continuing professional development’ (CPD). Simply put, CPD reflects the fact that, forpharmacy professionals to practise with responsibility andaccountability, each one must structure a plan and implementmechanisms by which they can maintain their individual competence. It also indicates a willingness of the individual practitioner to build a portfolio of formal and informal educationalprocesses in which they are continuously engaged to ensurecompetence. They are also willing to have this portfolioreviewed by their peers and perhaps, regulatory bodies, toestablish a formal recognition of competence by external parties. Our profession will be examining these precepts over thecoming years as a necessary evolution of our thinking aroundcontinuing education, public accountability and personal professional development.Engaging in review of important developments in the fieldof pharmacy and the disciplines that support its knowledge
xForeword to the first editionsystem is a personal responsibility that all practitioners musttake seriously.This is particularly true at this time in the evolution of ourprofession. As we globally embrace the precepts of pharmaceutical care, as we find an appropriate balance between knowingour products, our patients and their disease states, it is increasingly critical to constantly review new findings as well as legacyprinciples. One way of doing that is self-assessment.Shaping a personal way of assessing one’s knowledge is animportant commitment to continuous professional development and demonstration of personal competence. Self-assessment that is taken seriously has the capacity to identify areaswhere further ‘sharpening’ is needed. It also provides the capacity to validate what one knows related to the competencerequirements of one’s practice. Such assessment is not a comparison of what one knows compared with others but rather,focuses on the skills, knowledge and attitudes that are relevantto an individual’s practice.MCQs in Pharmacy Practice is an important effort toengage individual pharmacists in such self-assessment. Theauthors of this text have identified a way by which individualpharmacists, who are committed to their own continuing professional development, can apply a systematic way of involvingthemselves in self assessment.This text provides a guided way of asking important questions, pointing out salient features of rational drug therapy andstimulating deeper thinking through a variety of exercises.Pharmacists who work their way through this book willassuredly gain in their knowledge and skills. More importantly,they will be able to identify those areas in which they may needdeeper study. But going through only this text will not ensurepractice competence. The need to stay current with the contemporary literature, involving oneself in formal lecture programmes, being part of intra- and inter-professional scientificdialogue and myriad other ways in which one sharpens one’sskills, will still be important engagements. By blending these
Foreword to the first editionxiefforts with structured self-assessment, such as that offered byMCQs in Pharmacy Practice, the individual practitioner willhave taken major steps in ensuring individual competence.Henri R Manasse, Jr, BS, MA, PhD, ScD, RPhExecutive Vice President and Chief Executive OfficerAmerican Society of Health-System Pharmacists,Bethesda, Maryland, USADecember 2002
Preface to the second editionThe first edition of the book MCQs in Pharmacy Practice waspublished in 2004. This timeframe gave assessors of professionals practising in the health field time to follow the evolvement of the different forms of MCQs. Six years ago, adoptinga multiple choice format as opposed to the traditional essaytype was a daring task with all its implications on how muchfairer the new system was over the traditional one.In this second edition, Lilian Azzopardi has succeeded tomove further away from the True/False type of setting to morechallenging formats. The newer types of MCQs demandappreciation of the subject whereby knowledge accrued istested by having to judge whether the first of two statementsis true and decision-making skills are required to decidewhether the second statement is a correct explanation of thefirst. Another format which has the advantage not only oftesting factual knowledge but also that of mimicking realisticclinical situations is where the student has not only to selectthe route or product to use but also to be able to indicate thenext best option while identifying which other option wouldbe least suitable. Such questions are ably set while still allowing for an unbiased assessment. The extension of the types ofsetting, albeit more demanding on the contributors, make thesecond edition of MCQs in Pharmacy Practice truly comprehensive in style. Such questions also provide the student witha refreshing exercise in mind juggling with pharmaceuticalprinciples.
xivPreface to the second editionThe BNF recommended for use with the first edition ofMCQs in Pharmacy Practice was the 44th edition. At the timeof writing this preface, the latest edition of the British NationalFormulary (BNF 57) was published. The editor has thereforeupdated the information in the questions to reflect that in thecurrent BNF, so as to ensure that the questions are practical andcontemporary. The answers given to the questions, which againform an essential part of this edition have been meticulouslyupdated by Lilian M Azzopardi, recently appointed Head ofDepartment of Pharmacy in the Faculty of Medicine andSurgery. In this capacity Lilian Azzopardi acts as chairperson ofthe examination boards in pharmacy practice including thefinal examination (which is in an MCQ format) that leads toregistration as a pharmacist. As Dean of the Faculty ofMedicine and Surgery, to which the department of pharmacybelongs, I could read in this text the meticulousness and diligence that are so characteristic of the attributes that ProfessorAzzopardi possesses.Professor Godfrey LaFerlaDean and Head of Department of Surgery, Faculty ofMedicine and Surgery, University of MaltaChairman, Department of Surgery, Mater Dei Hospital, MaltaApril 2009
Preface to the first editionFor many years pharmacy education was based on the study ofa number of ‘classic’ basic and applied sciences such as chemistry, mathematics, pharmaceutics, pharmacognosy and pharmacology. Students were then examined separately in thesedifferent disciplines. It is only fairly recently that pharmacypractice and pharmaceutical care have been introduced asintegral parts of the pharmacy curriculum. Attempts at findingthe best way to test the competence of pharmacy studentswere made at roughly the same time.Educationalists in many different disciplines have soughtways of testing objectively a student’s knowledge of a subject.A perfectly fair examination is one in which students are objectively and accurately assessed with regard to their comprehension, analysis, evaluation and application of all the materialwith which they have been presented during their course ofstudies. Multiple choice questions have been accepted as suchan objective measure in most areas, including those related toprofessional practice.Pharmacy practice has, until very recently, been examinedthrough the traditional essay type of question. This has led, attimes, to the feeling that the overall assessment of this disciplinecould be a subjective one. The MCQ system tries to eliminatethe subjective element in an examination and is now well established as a fair mode of assessment. The availability of a pharmacy practice text based on the MCQ system now providespharmacy students with the opportunity of assessing themselves
xviPreface to the first editionin the discipline and finding out whether they have mastered it.Dr Azzopardi and her collaborators are to be congratulated inhaving managed to produce this text. Dr Azzopardi’s book hasboth breadth and depth and should test a student’s knowledgerigorously. It should be a welcome addition to the standardtexts students use during the years spent in training to becomepharmacists.Roger Ellul-MicallefRector, Professor and Head of DepartmentClinical Pharmacology and Therapeutics,University of Malta, MaltaDecember 2002
IntroductionThe statement by John Biggs (Teaching for Quality Learning atUniversity. Milton Keynes: Open University Press, 1999) that‘assessment drives student learning’ is still as true today as itwas in 1999 and can be applied equally to undergraduate learning and continuing professional development (CPD). In bothareas, access to assessment tasks that allow for self-assessmentof knowledge across a broad range of domains is important.MCQs in Pharmacy Practice 2nd edn contains a broad range ofmultiple-choice questions that provide feedback on what isknown and where knowledge is lacking. This information isuseful to many potential users — the pharmacy undergraduate,the preregistrant, the university professor and the practisingpharmacist.At all levels, understanding the limitations in our knowledge and abilities is a critical step in the learning process.Learning that is based on individual knowledge gaps is morelikely to be effective and the learner is more motivated. Theability to identify one’s own learning needs is often a challenging and time-consuming process, even though the results can berewarding. MCQs in Pharmacy Practice 2nd edn is a simple-touse, useful, unintimidating text that enables users to determinethe extent of their knowledge, to identify knowledge gaps andto test their ability to analyse information and to make decisions.This text is primarily aimed at preparing students to sit formultiple choice question (MCQ) examinations in pharmacyand would therefore be a valuable study tool for studentspreparing for registration and would also assist in preparation
xviiiIntroductionfor other types of examination, such as oral examinations. Itprovides students and pharmacists with an excellent resourceto test their knowledge and to highlight areas where theyrequire further work.In the undergraduate setting there are many opportunitiesthroughout the curriculum for students and professors to utiliseMCQs to assess knowledge in particular areas. MCQs inPharmacy Practice 2nd edn would therefore make a usefulprescribed text to guide self-directed study for undergraduatepharmacy students. Continual, regular assessment of studentsprovides a form of feedback to students on the level of knowledge gained and areas where additional work is needed. Thistext would be of equal value if sections of the text were givento students as regular formative assessment or if students usedthe text as a study guide.The primary aim of professional development in pharmacyis to develop and maintain competencies, which improve standards of care and health outcomes for patients. Knowledge is acritical element in this process and community pharmacistsinvest significant time and money undertaking CPD. One of themajor barriers to effective CPD is motivation to undertake further learning reflected in reasons given for lack of engagementwith CPD, such as lack of time, cost and lack of engagementwith educational formats. A contributing factor to this lack ofengagement is the inability to match individual learning needswith educational offerings. These questions provide an excellent tool to enable practising pharmacists to assess their ownknowledge in a variety of relevant areas. Once gaps in knowledge are identified, it is a simpler process to undertake selfdirected learning that addresses deficiencies and CPD istherefore more stimulating and meaningful and likely to lead toa change in practice.Multiple choice questions are time consuming and difficultto develop in a manner that ensures appropriate assessment ofknowledge and critical thinking skills. The questions in MCQsin Pharmacy Practice 2nd edn are of an excellent standard and
Introductionxixthe format, variety and structure make it an essential resourcefor the pharmacy profession.Associate Professor Jennifer MarriottDirector, Bachelor of Pharmacy Course, Faculty ofPharmacy and Pharmaceutical Sciences, Monash University,AustraliaPresident, Academic Section, InternationalPharmaceutical Federation
AcknowledgementsI would like to thank colleagues and friends who have supported me in completing the second edition of this book. I ammost grateful to the contributing authors: Anthony SerracinoInglott and Maurice Zarb Adami from the University of Malta,Steve Hudson from the University of Strathclyde and Sam Salekfrom the University of Cardiff. I would like to thank pharmacists Alison Anastasi and Louise Azzopardi for their participation in reviewing the material. Gratitude is also due to JuanitoCamilleri, Rector, and Godfrey Laferla, Dean of the Faculty ofMedicine and Surgery, University of Malta for their constantsupport.Thanks also go to staff and students at the Department ofPharmacy especially Amanda Calleja and staff at the Faculty ofMedicine and Surgery. I would like to acknowledge the assistance received from staff at Pharmaceutical Press, particularlyChristina DeBono and Louise McIndoe.
About the editorLilian M Azzopardi studied pharmacy at the University ofMalta, Faculty of Medicine and Surgery. In 1994 she took up aposition at the Department of Pharmacy, University of Malta asa teaching and research assistant. Professor Azzopardi completed an MPhil on the development of formulary systems forcommunity pharmacy in 1995, and in 1999 she gained a PhD.Her thesis led to the publication of the book ValidationInstruments for Community Pharmacy: pharmaceutical carefor the third millennium published in 2000 by PharmaceuticalProducts Press, USA. She worked together with ProfessorAnthony Serracino Inglott who was a pioneer in the introduction of clinical pharmacy in the late sixties. Professor Azzopardiis the author of Further MCQs In Pharmacy Practice (2006)and MCQs in Clinical Pharmacy (2007) by PharmaceuticalPress.Professor Azzopardi is currently an associate professor inpharmacy practice at the Department of Pharmacy, Universityof Malta and is responsible for coordinating several aspects ofteaching of pharmacy practice, including clinical pharmacy forundergraduate and postgraduate students, as well as supervising a number of pharmacy projects and dissertations in thefield. She is an examiner at the University of Malta for studentsfollowing the course of pharmacy and is an assessor in determining suitability to practice.Lilian Azzopardi was for a short period interim directorof the European Society of Clinical Pharmacy (ESCP) and iscurrently coordinator of the ESCP newsletter. She served as a
xxivAbout the editormember of the Working Group on Quality Care Standardswithin the Community Pharmacy Section of the InternationalPharmaceutical Federation (FIP). She was a member of thePharmacy Board, the licensing authority for pharmacy in Maltafor a number of years and Registrar of the Malta College ofPharmacy Practice, which is responsible for continuing education. In 1997 she received an award from the FIP Foundationfor Education and Research and in 1999 gained the ESCPGerman Research and Education Foundation grant. She haspractised clinical pharmacy in the hospital setting and shepractises in community pharmacy.Lilian Azzopardi has published several papers on clinicalpharmacy and pharmaceutical care and has actively participated at congresses organised by FIP, ESCP, RPSGB, APhA andASHP. She has been invited to give lectures and short courses inthis area in several universities. She has been a member ofscientific committees for European conferences and chaired anumber of oral communication sessions reporting researchwork in the field of pharmacy practice. She has received funding for her research projects from national institutions and in2008 completed a project funded by the European Union onautomated dispensing of pharmaceuticals and pharmacistinterventions, of which she was project coordinator for theUniversity of Malta. In 2008 Professor Azzopardi wasappointed head of the department of pharmacy at theUniversity of Malta.
ContributorsLilian M Azzopardi BPharm (Hons), MPhil, PhD, MRPharmSAssociate Professor and Head of Department, Department ofPharmacy, Faculty of Medicine and Surgery, University ofMalta, Msida, MaltaStephen A Hudson MPharm, FRPharmSProfessor of Pharmaceutical Care, Division of PharmaceuticalSciences, University of Strathclyde Institute of Pharmacy andBiomedical Sciences, University of Strathclyde, UKSam Salek PhD, RPh, MFPM (Hon)Professor and Director, Centre for Socioeconomic Research,Welsh School of Pharmacy, Cardiff University, UKAnthony Serracino-Inglott BPharm, PharmD, MRPharmSProfessor, Department of Pharmacy, University of Malta,Msida, MaltaMaurice Zarb-Adami BPharm, BPharm(Lond), PhDSenior Lecturer, Department of Pharmacy, University of Malta,Msida, Malta
How to use this bookThis book provides an ideal revision guide for those preparingto sit for a multiple choice questions (MCQs) examination inpharmacy. It covers common general pharmacy practice interventions and operations and other topics commonly featuredin examinations, such as simple pharmaceutical calculations,doses, strengths, nomenclature, abbreviations, dosage forms,specialities, trade and generic names, biochemical tests, classification, side-effects, and common diseases. Some recentadvances in pharmacy practice are also included.It is recommended that students use this book in their finalpreparatory stage before sitting for qualifying, licensing or registration examinations so that they are aware of the nature ofthe questions likely to be posed and how best to approach theexamination. This series of MCQ tests is aimed at preparingcandidates for their registration examination, whether this iscarried out by the state board, the pharmaceutical society or theuniversity. In setting out a broad range of typical MCQs, theaim is to test the level of the candidate’s knowledge, as well ashelping to reinforce specific points and refine the examinationtechnique.This book consists of 800 examination-type MCQs (300of which are new questions and over 30 new drug entities areincluded). The questions are practice oriented and are intendedto assess knowledge, evaluative and analytical skills, andability to apply that knowledge in clinical practice.The book consists of two parts. The first is an open-booksection wherein the questions aim to assess the student’s ability
xxviiiHow to use this bookto apply their knowledge in a practice setting in conjunctionwith the use of information sources. In the second part, theclosed-book section, MCQs are directed towards basic skillsand knowledge with which the student is expected to be fullyfamiliar.Each test consists of 100 questions which should be completed in two hours. In each test, different formats of MCQs areadopted. Each format is introduced with directions for answering the MCQs. In each test, case-based and free-standing questions are included. Answers with brief explanations are given atthe end of each test.For each test, write the number of the question and youranswer on a separate sheet of paper, then after going throughall the questions in the test, compare your answers with thosein the book. Attempt one open-book test and one closed-booktest so as to mimic examination conditions. Refer to AppendixD for feedback on those questions you did not answer correctly.Information on the proprietary names listed in the book is givenin Appendix A. Appendix B includes definitions of medicalterms included in the book, while Appendix C lists abbreviations and acronyms.The recommended textbooks for the open-book section are:Azzopardi LM (2000). Validation Instruments forCommunity Pharmacy: Pharmaceutical Care for theThird Millennium. Binghamton, New York:Pharmaceutical Products Press.Edwards C, Stillman P (2006). Minor Illness or MajorDisease? The Clinical Pharmacist in the Community,4th edn. London: Pharmaceutical Press.Joint Formulary Committee (2009). British NationalFormulary, London: Pharmaceutical Press.Medicines, Ethics and Practice: a Guide for Pharmacistsand Pharmacy Technicians, 32, July 2008. London:Royal Pharmaceutical Society of Great Britain, 2008.Nathan A (2006). Non-prescription Medicines, 3rd edn.London: Pharmaceutical Press.
How to use this bookxxixThis book is mainly meant for those sitting the final testbefore being registered as pharmacists. This test is considered tobe one of the most challenging tasks in a student’s training. Thesyllabus and specific requirements regarding eligibility to sit forthe examination have been carefully laid down by the relevantauthorities but the aim is always the same: namely, an attemptto set the required standards of professional skills and ability.The format of the examination itself has been selected to testthese standards thoroughly. These preregistration examinationsare a necessary obstacle to overcome in becoming a professional pharmacist, in whose hands patients are safe and who isa credit to the profession.The MCQs method of assessing students is here to stay.MCQs are no longer regarded as an examination that constitutes a final handshake for those who have completed fouryears at university, passed all the tests, practised in the pharmacy service, gained experience and have received a good reportfrom their mentor pharmacist. Indeed, a poor performance inthis assessment may result in overall failure.MCQs in pharmacy practice do not simply examine facts.Some students expect MCQs to test only factual knowledge.However, questions are also set to test the candidate’s ability tocomprehend the statements, analyse them and give a logicalanswer. Some MCQs also test the ability to make safe clinicaldecisions, and occasionally even test the candidate’s professionalbearing.Thorough preparation for an MCQs examination is essential — the information gained and stored during pharmacypractice sessions carried out in a pharmaceutical environmentwill form the foundation of the candidates’ knowledge toenable them to pass the examination.
xxxHow to use this bookPreparing and sitting for MCQs in pharmacy practiceAdvice about answering MCQs is not very different from thatfor any other examination, whether oral or written. Startingwith dress, there is a tendency to match your psychological outlook and actions to the way you are dressed. Some studentsapproach MCQ tests casually, as if this type of examinationwere not as serious an undertaking as any other. Dress smartlybut comfortably and conservatively. Avoid clothes that makeyou feel too relaxed, such as casual jackets or leisure wear.Arrive a little early for the examination and plan howmuch time to allocate for each question, allowing extra time formore difficult questions.Open-book examinationsThe rarity of absolutes in pharmacy practice means that a variety of adjectives and adverbs are commonly used in its description, increasing the difficulty of answering MCQs. Althoughthe desirability of assessing knowledge that is dependent on the‘strength’ of an adjective can be questioned, these adjectives doform part of the language of present-day pharmacy practice,borne out by their frequent use in the questions and answerspresented in this book. You should not assume they are clues —they may or may not be.The following are suggestions about how to tackle thequestions in Test 1 of this book. These pointers may be appliedto the other tests in this publication. The questions are tackledin groups and a number of points are considered. However,some of the points discussed may certainly be adopted inanswering other questions. Sometimes the open-book questionsmay even present more of a challenge than the closed-bookquestions. In the case of Test 1, which is an open-book examination, there is also advice about the best use of reference bookswithin the time allowed for answering the MCQs.
How to use this bookxxxiQuestions 1–25Several questions contain the statement: ‘All EXCEPT’.In this book, ‘except’ is in capital letters (upper case) but not alltexts use this convention. More important is the fact that onlyone answer — one choice — is allowed. This is explained in thestatement at the beginning of the questions.Never underestimate the importance of reading the directions very carefully. In this case, the directions state: ‘Select thebest answer in each case.’ (Note the use of the word ‘best’.) Donot spend too much time, however, selecting the ‘best’ answer— very often there is only one correct answer. Candidates whoselect more than one answer will not be given any marks, evenif the choice includes the correct answer.Another type of question includes the word ‘NOT’ —again this book uses upper case but this may not be so in allexaminations, so watch out for such words (for example, inQ4).Do not be unduly perturbed by the
focuses on the skills, knowledge and attitudes that are relevant to an individual’s practice. MCQs in Pharmacy Practiceis an important effort to engage individual pharmacists in such self-assessment. The authors of this text have identified a wa
MCQs 261-330 115 EMQs 331-340 139 6 Special senses MCQs 341-384 149 EMQs 385-394 163 7 Urinary system MCQs 395-434 171 EMQs 435-444 185 8 Endocrine system MCQs 445-501 193 EMQs 502-512 211 9 Reproductive system MCQs 513-567 219 EMQs 568-576 237 l0. General questions MCQs 577-639 245 EMQs 640-649 265 11 Sport and exercise physiology MCQs 650-686 .
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